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Comparison of cumulative dissipated energy and endothelial cell loss after phacoemulsification: a pilot study

Poster Details

First Author: G.Godinho PORTUGAL

Co Author(s):    C. Madeira   A. Moleiro   P. Neves-Cardoso   P. Freitas-Costa   F. Falcão-Reis   J. Macedo     

Abstract Details


The optimization of the several phacoemulsification parameters is necessary to achieve better surgical outcomes. Intraoperative cumulative dissipated energy (CDE) is a parameter easy to control and assess during surgery and with great variability between procedures and surgeons. This study aims to evaluate endothelial cell loss after phacoemulsification and correlate it with intraoperative cumulative dissipated energy (CDE).


This study took place in the Ophthalmology Department of Centro Hospitalar e Universitário São João, in Porto, Portugal between January and March of 2020.


This was a prospective, non-randomized, longitudinal pilot study in which patients submitted to uncomplicated phacoemulsification were enrolled. Eyes with prior history of intraocular surgery, corneal disease or uveitis were excluded. All phacoemulsifications were performed by the same surgeon (GG), using horizontal phaco chop technique, and intraoperative cumulative dissipated energy (CDE) was registered. The main outcome measure was endothelial cell density (ECD) (Specular Microscope SP-3000P), which was evaluated before the surgery and 1-month postoperatively.


Fifteen eyes from 15 patients, with a mean age of 70.1±7.7 years, were included. Before surgery, ECD was 1887.5±439.8 cells/mm2. The mean intraoperative CDE was 6.3±4.8. Post-operatively, there was a decrease in ECD (p=0,001) and the ECD difference was 532.4±393.2 cells/mm2, representing a loss of 28.2%. Endothelial cell loss was not related to age (p=0.694) nor with gender (p=0.624). A moderate correlation was found between endothelial cell loss and intraoperative CDE (p=0.050 R=0.514).


A decrease in ECD was found with phacoemulsification. Even between surgeries with a low difference of intraoperative CDE, a correlation was found with endothelial cell loss. As so, smaller intraoperative values of CDE could lead to smaller endothelial cell loss.

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